Provider Demographics
NPI:1912267170
Name:COVENANT LIVING CENTER, INC.
Entity Type:Organization
Organization Name:COVENANT LIVING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLUWASEYI
Authorized Official - Middle Name:
Authorized Official - Last Name:OYEWALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-480-4345
Mailing Address - Street 1:7423 BRIGHT LAKE BEND LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-5241
Mailing Address - Country:US
Mailing Address - Phone:713-480-4345
Mailing Address - Fax:281-879-0816
Practice Address - Street 1:7423 BRIGHT LAKE BEND LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-5241
Practice Address - Country:US
Practice Address - Phone:713-480-4345
Practice Address - Fax:281-879-0816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)